Abstract
Introduction Managing patients who return home after commercial transplantation in a foreign country and those considering travel abroad, may create ethical dilemmas for donation and transplantation professionals. Research in the Netherlands suggests approximately 35% of transplant professionals are likely to encounter at least one returning transplant “tourist”,[1] however the prevalence of such experience internationally is unknown. Methods A working group of the Ethics Committee of The Transplantation Society (TTS) conducted a study investigating professional experience of ethical issues in donation and transplantation. Participants were recruited via email to participate in an anonymous survey in English or Spanish. Survey items addressed participant demographics and professional experience of ethical issues or concerns in specific domains of donation and transplantation practice. Invitations were sent to TTS members and to the leadership of national and regional transplantation professional societies, for dissemination among members and colleagues. Data were collected between January 27- May 1, 2016. Selected data pertaining to reported experience of issues relating to organ trade, transplant tourism and financial incentives for donation are presented in this paper. Results 864 respondents from 84 countries completed the survey (44% Europe; 20% North America; 12% Latin America; 9% Asia; 8% Middle East; 4% Australia and New Zealand; 2% Africa). 40% of respondents were physicians; surgeons (23%); donor or transplant coordinators (21%); other (16%). 33% of respondents (n = 281) reported personal experience of ethical issues relating to organ trading, transplant tourism or incentives for donation. Among nephrologist respondents, the proportion with such experience was 47% (n = 85). Of all respondents with such experience, 66% reported experience of ethical concerns in retrospective management of transplant travellers; 57% prospective management of patients considering travel abroad to purchase an organ; 44% management of foreign patients who travelled for the purpose of donation or transplantation; 35% management of living donor-recipient pairs where a commercial relationship is suspected. Conclusions At least one third of transplant professionals may experience ethical dilemmas related to management of patients who have traveled, or are considering travel abroad for commercial transplantation, or who may be involved in organ trafficking. Guidance tools are urgently needed to support clinicians in managing such ethical dilemmas. The Transplantation Society Ethics Committee. Declaration of Istanbul Custodian Group. Reference: 1. Ambagtsheer F, Van Balen LJ, Duijst‐Heesters WLJM, Massey EK, & Weimar W. Reporting organ trafficking networks: a survey‐based plea to breach the secrecy oath. American Journal of Transplantation. 2015;15: 1759–1767.
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